腹部枪弹伤大动物模型的建立与应用研究.pdf
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1、第 40 卷第 5 期2023 年 10 月实验动物科学LABORATORY ANIMAL SCIENCEVol.40No.5October 2023论著收稿日期:2023-06-07基金项目:后勤科研项目(CKJ19C037)作者简介:饶桂荣(1974),女,副主任药师.研究方向:野外战创伤快速救护与动物模型研究.E-mail:raogr 通信作者:陈曦(1982),男,主治医师.研究方向:野外战创伤快速救护与动物模型研究.E-mail:892372342 腹部枪弹伤大动物模型的建立与应用研究饶桂荣 李 刚 杨吉武 王 洁 齐 颖 程奥飞 黄 晶 陈 曦(中国人民解放军南部战区空军医院,广州
2、510602)摘要:目的建立腹部枪弹伤大动物模型,并对腹部肠管破裂进行磁环吻合的初步应用研究,为野战手术的临床和基础研究提供理想动物模型。方法选用巴马小型实验猪,设置 5 和 10 m 两个距离使用国产 95 式步枪射击右下腹致伤,建立腹部枪弹伤动物模型。选取造模成功的动物,随机分两组分别进行磁环吻合术和手工缝合术,术中监测生命体征,记录手术完成时间。术后 3、7、10 d 进行 X 线检查观察磁环位置,并记录磁环排出时间。术后 4 周安乐死动物,观察肠吻合口愈合情况并进行病理检查。结果距离射击点 5 m 造模结果较为理想,枪弹伤的出入口均清晰可见,出血量少,肠管贯通伤明显,肠穿孔显示 1 个
3、或多个。距离射击点 10 m 的造模后动物出血量大,死亡超过半数。与传统手工缝合手术相比,采用磁环进行肠管破裂吻合需(2.080.14)min,两组手术时间差异有统计学意义(P0.01)。术后 X 线显示磁环存在肠管内,于术后 2 周内磁环随大便排出体外。组织学观察显示磁环组炎性细胞浸润优于缝合手术组。结论成功建立了腹部枪弹伤大动物损伤模型,吻合磁环在枪弹所致腹部肠管破裂伤的救治手术中具有较大优势,为未来用于野战创伤快速救治提供实验支持。关键词:腹部枪弹伤;动物模型;磁吻合中图分类号:Q95-3文献标志码:A文章编号:1006-6179(2023)05-0043-05DOI:10.3969/j
4、.issn.1006-6179.2023.05.008Establishment and Application Research in Animal Model ofAbdominal Gunshot WoundRAO Guirong,LI Gang,YANG Jiwu,WANG Jie,QI Ying,CHENG Aofei,HUANG Jing,CHEN Xi(Air Force Hospital of PLA Southern Theater Command,Guangzhou 510602,China)Abstract:Objective To establish an animal
5、 model of abdominal bullet wound,and study the application of rapid anastomotic magnetic ring in animal models of abdominal bullet wounds,providing ideal animal modeling for clinical and basic research of field surgery.MethodTo establish the animal model of abdominal bullet wound,right lower abdomen
6、 of Bama miniature pigs were injured with a domestic 95-type assault rifle.Qualified animal models were randomly divided into magnetic loop rapid anastomosis group and manual suture group.Intraoperative monitoring of vital signs and completion time of magnetic compression anastomosis were recorded.I
7、n the experimental group,to observe the position of the magnetic ring,X-ray examination was performed on the 3rd,7th and 10th days,and the discharge time of the magnetic ring were recorded.The animals were sacrificed 4 weeks after the operation,the healing of the anastomotic stoma was observed,and p
8、athological examination was conducted.ResultShooting from 5 m away animals,the modeling result were ideal.The entrance and exit of the bullet wound were clearly visible,the amount of bleeding was small,the intestinal penetrating injury was 实验动物科学40 卷obvious,and one or more intestinal perforations we
9、re displayed.While shooting from 10 m away,amount of bleeding was large and more than half of the animals died.It took about 2 minutes to perform intestinal anastomosis with a magnetic ring,which was about 20 minutes shorter than the traditional manual suture,and the differences were significant.Pos
10、t-operative X-ray showed that the magnetic ring was present in the bowel,and the magnetic ring was excreted with the stool within 2 weeks after the operation.Histological observation showed that the infiltration of inflammatory cells in the magnetic ring group was better than that in the suture grou
11、p.Conclusion An animal model of abdominal bullet wound was successfully established.Compared with the traditional manual suture,the anastomotic magnetic ring has great advantages in the treatment of abdominal intestinal rupture caused by bullets,providing experimental support for the rapid treatment
12、 of field wounds in the future.Key words:abdomen bullet wound;animal model;magnetic anastomosis现代战争中新型武器导致多脏器复杂枪弹伤明显增加,腹部战伤在战争中的发生率约为 7%,腹部肠管损伤后常因严重的腹腔感染和子弹等武器的特殊致伤效应而出现休克进而伴发脓毒症、多器官功能障碍综合征等,死亡率高达 25%左右1。因此,研究野战中腹部枪弹的救治成为现实课题,构建大动物枪弹伤模型,更真实模拟未来战场实情,以及如何快速快捷进行简单的战场急诊手术是控制腹腔感染、提高救治率的关键2。关于腹部枪弹伤大动物模型鲜有
13、报道,本研究借助新型武器模拟野战环境,构建大动物腹部枪弹模型,利用实验室自主研发的吻合磁环实施快速救治,为应对未来战场枪弹伤所致腹部消化道肠管破裂的批量伤员救治需求提供新技术研究基础。1材料和方法1.1材料1.1.1实验动物:实验用巴马小型猪,体质量(305)kg,购于广东明珠生物技术有限公司【SCXK(粤)2022-0061】。无菌手术在野战手术室平台进行。该实验通过单位动物伦理委员会审核,伦理审批号:NKYY-2019-001。1.1.2仪器与试剂:枪弹由空军军医大学专业教研室指导并提供,并在空军军医大学动物实验中心指导下进行。多参数心电监护仪(型号为 MP-700),麻醉机(型号为 Ae
14、on8300A),电动负压吸引器(型号为 YB-DX23B),液体如羟乙基淀粉、左氧氟沙星以及甲硝唑等其他药物均为南部战区空军医院中心药房领 取。吻 合 环 为 本 单 位 研 制,专 利 号 为 ZL 2020 2 2294785.1,如图 1 所示。图 1吻合用磁环Fig.1anastomotic magnetic ring1.2方法1.2.1腹部枪弹伤模型的建立:实验前禁食 12 h,禁饮 6 h。实验时 3%的戊巴比妥钠(或苯巴比妥钠)按 1 mL/kg 剂量注射大腿或臀部肌肉进行麻醉镇静。随后放置于动物支架上行侧仰位固定,使用国产 95 式突击步枪距离 5 和 10 m 实弹射击右下
15、腹麦氏点致伤,注意从右侧腹部斜向下射入,以避免损伤脾,射击后查看动物反应情况,于伤口创面予纱布包扎,如有出血予纱布填塞。用担架将致伤动物小心抬起并放置手术台上,进行救治的术前准备,并监测基本生命指征。1.2.2实验分组及手术:将成功制备的腹部枪弹伤动物模型随机分为两组:一组采用磁环快速吻合术,另一组采用传统手工缝合术。按野战手术规范操作进行,观察术中各项生命体征,手术救治过程中,实施静脉置管补液如羟乙基淀粉 250 mL、乳酸钠林格液 250 mL 及抗感染治疗,如左氧氟沙星 100 mL、甲硝唑 100 mL。沿腹壁弹道置入腹腔引流管,深约 10 cm,外接负压引流瓶。术后放置腹腔引流管引流
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